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Valerie G. Press, MD, MPH1 Aina Katsikas, PhD2 Kaylyn Swankoski, PhD2 Emily Boudreau, PhD2 Emily Thomas, PharmD2
Author Affiliations
- Department of Medicine, University of Chicago, Chicago, Illinois, United States
- Humana Inc., Louisville, Kentucky, United States
Address correspondence to:
Valerie G. Press, MD, MPH
University of Chicago
5841 S Maryland Ave MC 2007
Chicago, IL, 60637
Email: vpress@bsd.uchicago.edu
Abstract
Background: Individuals with chronic obstructive pulmonary disease (COPD) rely on inhaler-based medications to treat and control symptoms. Most patients do not use correct technique. Teach-to-goal (TTG) inhaler education programs have been found to improve inhaler technique. There is limited understanding as to whether TTG inhaler education is effective when delivered over the phone.
Objective: We aimed to find out the effect of a phone-based TTG inhaler technique education program among Medicare Advantage beneficiaries with COPD.
Study Design and Methods: Beneficiaries with a diagnosis of COPD within the prior 2 years, who had filled at least one maintenance inhaler prescription at least once in the prior year, had a value-based insurance design plan, and received the inhaler education component of the COPD intervention program were evaluated. Inhaler technique was measured by validated checklists, and patients self-reported their technique.
Results: Of 1876 patients analyzed, n=13 used more than one inhaler. At the initial assessment, 39.4% of participants were using their inhalers incorrectly. By the end of the first education session, the percentage of participants who were using their inhaler incorrectly decreased to 6.9%.
Interpretation: A phone-based TTG inhaler education program offered by a large national health plan demonstrated improvements in inhaler technique across different inhaler devices and subpopulations. The multiple-session approach was likely critical for longer-term retention of correct technique, though further study is needed to confirm this. Some subgroup populations are also at greater risk for baseline inhaler misuse and/or post-training inhaler misuse indicating a need for further evaluation of how to tailor inhaler education by individuals’ needs.
Citation
Citation: Press VG, Katsikas A, Swankoski K, Boudreau E, Thomas E. Phone-based teach-to-goal inhaler education program for Medicare advantage beneficiaries with COPD. Chronic Obstr Pulm Dis. 2026; 13(2): 84-92. doi: http://dx.doi.org/10.15326/jcopdf.2025.0667
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Na Zhao, MPH1,2* Ting Wei, MS1* Xinhai Huang, MS1 Guilan Wu, MS1 Ruijuan Li, MD3 Qiaowei Zheng, MD4 Xiumei Liu, MD5 Hengfen Dai, MD6 Xiangsheng Lin, BS7 Yuxin Liu, MD8 Jun Su, MD9 Xiaomin Dong, MS10 Cuifang You, MD11 Shuzheng Jiang, MD12 Yanxian Lan, MD13 Jinhua Zhang, PhD1
Author Affiliations
- Department of Pharmacy, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- School of Public Health, Fujian Medical University, Fuzhou, China
- Department of Pharmacy, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
- Department of Pharmacy, People’s Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- Department of Pharmacy, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
- Department of Pharmacy, Pingtan County General Laboratory Area Hospital, Fuzhou, China
- Department of Pharmacy, Huaihe Hospital of Henan University, Kaifeng, China
- Department of Pharmacy, the First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Department of Pharmacy, Affiliated Hospital of Guilin Medical University, Guilin, China
- Department of Pharmacy, Ningde Municipal Hospital Affiliated to Ningde Normal University, Ningde, China
- Department of Pharmacy, Traditional Chinese and Western Medicine Hospital of Wuhan,Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Pharmacy, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
* contributed to the work equally
Address correspondence to:
Jinhua Zhang, PhD
Department of Pharmacy
Fujian Maternity and Child Health Hospital
College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics
Fujian Medical University
#18 Daoshan Road
Fuzhou, 350001, China
Phone: 86 591 83357896 8301
Email: pollyzhang2006@126.com
Abstract
Background: Chronic obstructive pulmonary disease (COPD) may influence bleeding in atrial fibrillation (AF). We evaluated bleeding and all-cause death risks under warfarin versus direct oral anticoagulants (DOACs).
Methods: Based on a retrospective cohort from 12 centers of patients with AF on oral anticoagulation, we evaluated the associations of COPD and anticoagulant class with clinical outcomes using overlap-weighted logistic regression. Prespecified sensitivity and subgroup analyses were performed.
Results: COPD was associated with higher bleeding risk only among patients treated with warfarin (total bleeding: odds ratio [OR] 2.53, 95% confidence interval [CI] 1.00–6.45; risk difference [RD] 9.05%, 95% CI 0.15%–22.50%; minor bleeding: OR 3.00, 95% CI 1.09–8.24; RD 8.53%, 95% CI 0.56%–21.53%). Among patients with AF and COPD, DOACs were associated with reduced risks of total bleeding (OR 0.08, 95% CI 0.01–0.50; RD –8.4%, 95% CI -22.0% to -5.3%) and minor bleeding (OR 0.01; RD -9.5%, 95% CI -23.1% to -4.5%) compared with warfarin.
Subgroup analyses suggested that DOACs were associated with increased mortality at estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m² (OR 3.07, 95% CI 0.78–12.03; RD 9.9%) but lower mortality at eGFR <60mL/min/1.73m² (OR 0.20, 95% CI 0.05–0.78; RD -24.1%). Factor Xa inhibitors were associated with a higher major bleeding risk compared with dabigatran (OR 4.56, 95% CI 1.70–12.26; RD 10.2%, 95% CI 0.2%–20.1%; with a number needed to harm of 10).
Conclusions: In AF with comorbid COPD, DOACs minimize bleeding versus warfarin and may confer survival benefit in renal impairment. Differential bleeding risk should be considered when choosing among DOACs.
Citation
Citation: Zhao N, Wei T, Huang X, et al. Comparison of bleeding risks and all-cause death between warfarin and direct oral anticoagulants in patients with atrial fibrillation and chronic obstructive pulmonary disease: a multicenter retrospective cohort study. Chronic Obstr Pulm Dis. 2026; 13(2): 93-103. doi: http://dx.doi.org/10.15326/jcopdf.2025.0648
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Phan Thanh Thuy, MD, PhD1,2 Nguyen Thi Thu, MD2 Nguyen Cong Khan, MD, PhD3
Author Affiliations
- Hanoi Medical University, Hanoi, Vietnam
- Respiratory Center, Bach Mai Hospital, Hanoi, Vietnam
- Thang Long University, Hanoi, Vietnam
Address correspondence to:
Phan Thanh Thuy, MD, PhD
Hanoi Medical University
Hanoi, Vietnam
Email: phanthuy@hmu.edu.vn
Abstract
Background: Nocturnal symptoms and sleep disturbances are increasingly recognized as clinically important in chronic obstructive pulmonary disease (COPD) but remain understudied in low- and middle-income countries. The objective of this study was to assess sleep quality and determine its association with respiratory symptoms in Vietnamese outpatient COPD patients.
Methods: We conducted a cross-sectional study on 289 consecutive patients (≥ 40 years old) with a confirmed COPD diagnosis who were being monitored at the COPD management unit of Bach Mai Hospital, Hanoi (February2025 to May 2025). Demographic and clinical data (modified Medical Research Council [mMRC] dyspnea scale, COPD Assessment Test [CAT] score, forced expiratory volume in 1 second [FEV1] after bronchodilator use, comorbidities, and number of hospitalizations in the previous year) were collected through structured interviews and medical record reviews. Sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI).
Results: The mean PSQI total score was 9.2 ± 3.7; 85.8% of participants met the threshold for poor sleep. A total of 65.4% of patients had an mMRC grade ≥ 2, 88.9% had a CAT score ≥ 10, and 88.9% of patients had an acute hospitalization in the past year. A high CAT score, a high mMRC grade, long disease duration, and FEV1 below 50% were risk factors for impaired sleep quality as measured by the PSQI.
Conclusion: Poor sleep quality is highly prevalent among Vietnamese outpatient COPD patients and is closely associated with respiratory symptom burden and disease severity. These findings underscore the importance of routine sleep quality assessment in COPD management and suggest that optimizing symptom control may contribute to improved sleep and overall patient outcomes.
Citation
Citation: Thuy PT, Thu NT, Khan NC. Silent nights, restless lungs: sleep quality and associated factors among COPD patients in Vietnam—a cross-sectional study. Chronic Obstr Pulm Dis. 2026; 13(2): 104-110. doi: http://dx.doi.org/10.15326/jcopdf.2025.0664
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Jane C. Fazio, MD, PhD1,2 Andrew W. Hong, MD3 Daniela Markovic, MS4 R. Graham Barr, MD, DrPH5 Eugene R. Bleecker, MD6 Russell P. Bowler, MD, PhD7 David J. Couper, PhD8 Jeffrey L. Curtis, MD9,10 M. Bradley Drummond, MD, MHS11 Spyridon Fortis, MD, PhD, MSc12 MeiLan K. Han, MD, MS9 Victor Kim, MD13 Fernando J. Martinez, MD, MS14 Jill Ohar, MD15 Victor E. Ortega, MD, PhD16 Robert Paine III, MD17 J. Michael Wells, MD, MSPH18 Sheiphali A. Gandhi MD, MPH19,20 Prescott G. Woodruff, MD, MPH20 Nirupama Putcha, MD, MHS21 Christopher B. Cooper, MD, PhD1,22 Donald P. Tashkin, MD1 Russell G. Buhr, MD, PhD1,2,23* Igor Barjaktarevic, MD, PhD1* for the SPIROMICS investigators
Author Affiliations
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States
- Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, United States
- Department of Genomic Medicine, Cleveland Clinic, Cleveland, Ohio, United States
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
- Medical Service, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, Michigan, United States
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Division of Pulmonary, Critical Care and Occupation Medicine, Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, Unites States
- Division of Pulmonary, Allergy, and Critical Care Medicine, Chan Medical School, University of Massachusetts, Boston, Massachusetts, United States
- Department of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina, United States
- Division of Pulmonary Medicine, Mayo Clinic, Phoenix, Arizona, United States
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
- Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Division of Occupational, Environmental, and Climate Medicine, University of California San Francisco, San Francisco, California, United States
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, California, United States
- Division of Pulmonary, Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Department of Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California, United States
*Co-senior authors
Address correspondence to:
Jane C. Fazio MD, PhD
Division of Pulmonary and Critical Care Medicine
David Geffen School of Medicine
University of California
Los Angeles, CA
1100 Glendon Ave, Suite 850-861
Los Angeles, CA 90024
Email: jfazio@mednet.ucla.edu
Abstract
Rationale: Nebulizers are an alternative to handheld devices for inhaled therapies in chronic obstructive pulmonary disease (COPD). Understanding nebulizer utilization patterns is essential to developing therapy guidelines.
Objectives: We aimed to describe characteristics of nebulizer users versus nonusers and factors associated with baseline nebulizer use and longitudinal uptake.
Methods: We analyzed the Subpopulations and Intermediate Outcome Measures in COPD Study, a prospective cohort of 2973 participants with or without tobacco use and/or COPD. We used cross-sectional multivariable logistic regression and interval-censored proportional hazard models to analyze factors associated with nebulizer use and uptake among tobacco-exposed participants with preserved spirometry (TEPS) and COPD from enrollment (Visit 1) through 4–7 years of follow-up (Visit 5).
Results: Nebulizer utilization was highest in advanced COPD, 49% of Global initiative for chronic Obstructive Lung Disease (GOLD) Group D participants at baseline. Nebulizer treatments were primarily as-needed short-acting bronchodilators. Baseline nebulizer use was associated with respiratory exacerbations in the prior year (1, odds ratio [OR] 1.81, 95% confidence interval [CI] [1.24, 2.64]; 2, OR 1.86, 95% CI [1.07, 3.22]; 3 or more, OR 1.87, 95% CI [1.07, 3.28]), lower forced expiratory volume in 1 second (FEV1) (OR 2.81 per liter decrease, 95% CI [2.09, 3.77]), COPD Assessment Test (CAT) score >10 (OR 1.89, 95% CI [1.17, 3.03]), 6-minute walk distance (6MWD) (OR 1.03 per 10 meter lower 6MWD, 95% CI [1.02, 1.05]), and a history of asthma (OR 2.41, 95% CI [1.76, 3.30]). Longitudinal uptake was similarly associated with exacerbations, lower FEV1, CAT score >10, and asthma. Patterns were consistent between TEPS and COPD.
Conclusion: Nebulizers were predominantly used by participants with frequent exacerbations, high symptom burden, and advanced COPD, and long-acting nebulized medications were underutilized. Randomized controlled trials are needed to compare nebulizers with hand-held devices.
Citation
Citation: Fazio JC, Hong AW, Markovic D, et al. Exacerbations and decreased lung function predict nebulizer use and uptake in COPD and tobacco-exposed persons with preserved spirometry. Chronic Obstr Pulm Dis. 2026; 13(2): 111-124. doi: http://dx.doi.org/10.15326/jcopdf.2025.0714
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Daniel C. Belz, MD, MPH1* Ernesto Quiroz1* Han Woo, PhD1 Mariah K. Jackson, PhD, RD2 Nirupama Putcha, MD, MHS1 Ashraf Fawzy, MD, MPH1 Wendy Lorizio, MD, MPH1 Corrine K. Hanson, PhD, RD2 Nadia N. Hansel, MD, MPH1
Author Affiliations
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Medical Nutrition Program, College of Allied Health Professions, University of Nebraska, Omaha, Nebraska, United States
*Co-first authors
Address correspondence to:
Daniel C. Belz, MD, MPH
Division of Pulmonary and Critical Care Medicine
Johns Hopkins University
Baltimore, Maryland
Phone: (410) 955-3841
Email: dbelz2@jhmi.edu
Abstract
Introduction: Isoflavones, phenolic compounds in legumes and soy products, are linked to reduced risk of chronic diseases such as coronary heart disease. However, effects on respiratory diseases like chronic obstructive pulmonary disease (COPD) are understudied.
Methods: Former smokers with COPD were enrolled in a prospective cohort study. Morbidity was assessed at baseline, 3, and 6 months using the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), modified Medical Research Council (mMRC), St George’s Respiratory Questionnaire (SGRQ), Ease of Cough and Sputum Clearance (ECSC), and exacerbation history. Spirometry and biomarkers of platelet activation, inflammation, and oxidative stress were obtained. Dietary intake was assessed via a food frequency questionnaire, with total isoflavone intake calculated as the sum of genistein, daidzein, glycitein, formononetin, and biochanin A. Associations were analyzed with generalized estimating equation regression analysis and adjusted for baseline covariates.
Results: A total of 99 participants (mean age 66.4, 55% female, 41% White, and a baseline forced expiratory volume in 1 second percentage predicted of 49.8%) had a mean isoflavone intake of 1.8mg (standard deviation [SD]=3.1). One SD increase in total isoflavone intake was associated with lower CAT (β=–2.0, p=0.011), CCQ (β=–0.2, p=0.029), and ECSC (β=–0.70, p <0.001) scores, and 7.4% lower urinary 11-dehydro-thromboxane B2 (p=0.047). A trend toward better SGRQ scores was observed but was not significant. Isoflavones were not associated with mMRC or exacerbations.
Conclusion: Increased isoflavone intake was associated with improved respiratory morbidity and reduced platelet activation, suggesting a potential dietary pathway influencing COPD morbidity.
Citation
Citation: Belz DC, Quiroz E, Woo H, et al. Isoflavone intake is associated with decreased chronic obstructive pulmonary disease morbidity. Chronic Obstr Pulm Dis. 2026; 13(2): 125-135. doi: http://dx.doi.org/10.15326/jcopdf.2025.0695
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Mara Paneroni, PhD1* Laura Spinello, MSc1,2* Beatrice Salvi, BSc1 Carla Simonelli, BSc1 Aldo Diasparra, MD3 Massimo Venturelli, PhD2,4 Michele Vitacca, MD1
Author Affiliations
- Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Lumezzane, Italy
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Respiratory Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Institute of Marina di Ginosa, Marina di Ginosa, Italy
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, United States
*These authors equally contribute to the work.
Address correspondence to:
Michele Vitacca, MD
Respiratory Rehabilitation Unit
Istituti Clinici Scientifici Maugeri IRCCS
Via G Mazzini, 129 25065 Lumezzane, Italy
Email: michele.vitacca@icsmaugeri.it
Abstract
Background: Acute exacerbations of COPD (AECOPDs) may cause exercise-induced desaturation (EID), affecting recovery and rehabilitation outcomes. The prevalence and clinical implications of EID during early postexacerbation pulmonary rehabilitation are unclear. This study aimed to determine the prevalence of EID in COPD patients recovering from AECOPDs, with and without long-term oxygen therapy (LTOT) at rest, and to compare clinical, functional, and physiological characteristics.
Methods: This retrospective, multicenter study included 262 COPD patients admitted for inpatient pulmonary rehabilitation after AECOPDs. Participants were stratified by resting oxygen therapy status. EID was defined as a ≥4% fall in peripheral oxygen saturation from baseline with nadir <90% during the 6-minute walking test. Clinical, functional, and physiological parameters were compared across subgroups.
Results: Overall, 132 patients (50.4%) exhibited EID. Prevalence was higher in patients on oxygen at rest (61.5%) than in those breathing room air (33.9%, p <0.0001). Patients on oxygen therapy had greater lung function impairment, reduced exercise capacity, and higher dyspnea-related disability. EID was associated with greater heart rate response in patients on supplemental oxygen but not consistently with perceived dyspnea or fatigue, highlighting the importance of objective oximetry during exercise testing. Regardless of EID, individuals on oxygen walked shorter distances than those on room air.
Conclusions: EID is common in COPD patients recovering from AECOPD, especially those receiving LTOT, and is linked to more severe functional impairment. Systematic EID assessment using objective oximetry during early pulmonary rehabilitation may support individualized oxygen titration and exercise prescriptions. Prospective studies are needed to clarify its prognostic implications.
Citation
Citation: Paneroni M, Spinello L, Salvi B, et al. Prevalence of exercise-induced desaturation among COPD patients enrolled in early inpatient pulmonary rehabilitation. Chronic Obstr Pulm Dis. 2026; 13(2): 136-146. doi: http://dx.doi.org/10.15326/jcopdf.2025.0724
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Rainer Gloeckl, PhD1 Ruth Tal-Singer, PhD2 Peter Deussen, PhD3 Russell Winwood4,5 Tharishini Mohan, MD6 Megan Turner, BA7 Mohamed Hamouda, MPH8 Mandeep Moore, GPhC6 Paul Jones, MD, PhD9,10
Author Affiliations
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
- Global Allergy and Airways Patient Platform, Vienna, Austria
- Biomedical Research Group Oxford (PPI), Oxford, United Kingdom
- Inogen Global, Zurich, Switzerland
- COPD Baton Pass, Salisbury, United Kingdom
- Global Medical Affairs, General Medicines, GSK, London, United Kingdom
- Global Clinical Operations Research and Development, GSK, Collegeville, Pennsylvania, United States
- Value Evidence and Outcomes Research, GSK, Dubai, United Arab Emirates
- Advanced Pipeline Unit Respiratory, GSK, London, United Kingdom
- Institute of Infection and Immunity, City St George’s, University of London, London, United Kingdom
Address correspondence to:
Rainer Gloeckl, PhD
Schoen Klinik Berchtesgadener Land
Malterhoeh 1
83471 Schoenau am Koenigssee
Germany
Phone: 49 8652 931630
Email: rgloeckl@schoen-klinik.de
Abstract
Background: The Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Recognition Tool (CERT) was developed to improve patients’ recognition of COPD exacerbations. This validation study concerned the cross-cultural and linguistic validation of 46 CERT translations across 25 countries and 6 continents.
Methods: This study employed a rigorous, certified (International Organization for Standardization-17100) methodology. Dual forward translations for each language were developed by independent translators who were native speakers of the target language and then reconciled by a linguistic validation consultant (LVC). Independent linguists provided a back translation of the reconciled translation, which was reviewed by the LVC and project manager. Linguistic validation was performed for each language through cognitive debriefing interviews with at least 5 participants with COPD who were native speakers of the target language. These participants also reviewed 7 sets of images produced for different global regions to reflect patients from a diversity of cultures, countries, and religions, to determine if the images were representative of themselves and/or other people living with COPD. The images were amended as needed and reshown to the participants for approval.
Results: The translations were found to be conceptually equivalent to the original CERT and harmonized with each other. Participants found the CERT easy to use and understand and confirmed that the images were representative of themselves and/or other people living with COPD.
Conclusion: CERT translations were created using a patient-centric approach and appear to be easily understandable and valid across many languages and cultures.
Citation
Citation: Gloeckl R, Tal-Singer R, Deussen P, et al. COPD exacerbation recognition tool: translation, linguistic, and cross-cultural validation. Chronic Obstr Pulm Dis. 2026; 13(2): 147-157. doi: http://dx.doi.org/10.15326/jcopdf.2025.0745
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Titas Grabauskas, BA1 Amanda E. Brunton, MS, MPH2 Mark L. Metersky, MD1 Kevin Winthrop, MD3 Nicole C. Lapinel, MD4 George M. Solomon, MD5 Kunal Jakharia, MD6 Michelle Korah-Sedgwick, MD7 Alexander Geyer, MD8
Author Affiliations
- School of Medicine, University of Connecticut, Farmington, Connecticut, United States
- Bronchiectasis and NTM Association, Miami, Florida, United States
- Divisions of Infectious Diseases and Ophthalmology, Oregon Health and Science University, Portland, Oregon, United States
- Pulmonary Critical Care, Northwell Health, New Hyde Park, New York, United States
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
- Pulmonary and Critical Care, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Pulmonary/Critical Care and Allergy/Immunology, Louisiana State University School of Medicine, New Orleans, Louisiana, United States
- Division of Pulmonary, Critical Care and Sleep Medicine, Lenox Hill Hospital at Northwell Health, New York, New York, United States
Address correspondence to:
Alexander Geyer, MD
Division of Pulmonary, Critical Care and Sleep Medicine
Lenox Hill Hospital at Northwell Health
New York, NY
Email: ageyer@northwell.edu
Abstract
Background: Pseudomonas aeruginosa (P aeruginosa), Haemophilus influenzae (H influenzae), and Staphylococcus aureus (S aureus) may chronically infect bronchiectatic airways. Chronic rhinosinusitis (CRS) is common in people with bronchiectasis. Bacterial airway infection and CRS are associated with greater bronchiectasis disease severity. However, the relationship between these pathogens and CRS in people with bronchiectasis is unclear.
Research Question: Is history of CRS associated with sputum positivity for P aeruginosa, S aureus, and/or H influenzae in people with bronchiectasis?
Study Design and Methods: People with bronchiectasis from the U.S. Bronchiectasis and NTM Research Registry with and without physician-reported CRS were compared with respect to demographic and clinical characteristics using cross-sectional study design. Multivariable logistic regression models were used to assess the relationship between CRS and the presence of P aeruginosa, S aureus, and H influenzae in sputum.
Results: Of 1352 people with bronchiectasis and known CRS status, 222 (16%) had a history of CRS. Those with CRS were more likely to have a sputum culture positive for P aeruginosa (35% CRS versus 26% non-CRS group; p=0.007), but not S aureus (13% versus 10%; p=0.21) or H influenzae (6% versus 7%; p=0.55). After adjusting for patient demographics and clinical characteristics, CRS was associated with P aeruginosa (odds ratio: 1.5; 95% confidence interval: 1.07 to 2.08).
Interpretation: We report an association of history of CRS and sputum culture positivity for P aeruginosa (but not S aureus or H influenzae) in people with bronchiectasis.
Citation
Citation: Grabauskas T, Brunton AE, Metersky ML, et al. Association of chronic rhinosinusitis and Pseudomonas aeruginosa in sputum of patients with non-cystic fibrosis bronchiectasis. Chronic Obstr Pulm Dis. 2026; 13(2): 158-166. doi: http://dx.doi.org/10.15326/jcopdf.2025.0732
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